1Chemotherapy, National Cancer Research Center of Uzbekistan, 100174 - Tashkent/UZ

2Gynecology, National Cancer Research Center of Uzbekistan, 100174 - Tashkent/UZ

Abstract

Aim/Background

To study the effectiveness of extracorporeal immunopharmacotherapy (EIFT) to improve the results of treatment of patients with cervical cancer.

Methods

We studied the data of 94 III-IV stage cervical cancer patients who had received comprehensive treatment, after which in 35 (37.2%) patients showed progression of the disease and 59 (62.8%) relapses. All patients received cisplatin 50 mg/m2 and pemetrexed 500 mg/m2 every 3 weeks until disease progression or severe toxicity. Patients were divided into the following groups: 1) control with no immunotherapy - 34 (36.2%); 2) without EIFT plasmapheresis - 32 (34.0%); 3) with plasmapheresis EIFT - 28 (29.8%). Thymalinum was used as an immunomodulator.

Results

In the control group patients experienced inhibition of myelopoiesis, toxic damage to the kidneys, myocardium, and liver, and signs of immunodeficiency. Under the influence of EIFT there was marked decrease in the degree of endotoxic syndrome. In the control group the most common grade 3-4 toxicity was neutropenia (32.6%) and the metabolic disorders (27.3%). After the EIFT grade 3-4 toxicities are no longer met, with the exception of alopecia. Median progression-free survival (PFS) in the group with EIFT was 7.2 months (95% CI 6.5-7.9), in the group with EIFT and plasmapheresis - 7.7 months (95% CI 7.2-8.2), and in the control group - 5.7 months, (95% CI 4.8-6.6), (p = 0.0031). Median overall survival (OS) in the group with EIFT was 13.5 months (95% CI 11.3-15.7), in the group with EIFT and plasmapheresis - 14.2 months (95% CI 12.1-16.3), and in the control group - 12.4 months (95% CI 10.8-13.9; p = 0.0027). Observable risk ratio (hazard ratio, HR) of progression in the group with EIFT (HR 0.737; 95% CI 0.665-0.809; p = 0.035) was reduced up to 26.3% compared with the control group, and death risk ratio (HR 0.911; 95% CI 0.868-0.954; p = 0.031) - 8.9%. In the group with EIFT and plasmapheresis these figures were (HR 0.649; 95% CI 0.586-0.712; p = 0.037) and (HR 0.855; 95% CI 0.794-0.916; p = 0.034) and the reduction of their composition 35.1% 14.5%, respectively.

Conclusions

The findings suggest the possibility of significant improvement of efficiency of new treatments of progressive cervical cancer using methods of accompanying immunotherapy.